Tinnitus, Headaches and Constant Exhaustion? Doctor Xue Lizhai Treats Qi Deficiency with Buzhong Yiqi Tang and Liuwei Dihuang Wan (Nourishing Both Qi and Yin)
Search terms this page answers: tinnitus / ears ringing all the time / headache / no energy at all / body always tired / fever every afternoon / sweating day and night / period stopped coming / dieting ruined my spleen and stomach
Medical terms: sinking of middle qi · qi deficiency · deficiency of both qi and yin · amenorrhea · yin deficiency with inner heat · weak spleen and stomach
Opening: three symptoms sitting together — and half the answer is already hidden in them
Today we continue with the case records of Doctor Xue Lizhai (Xue Ji), head of the Imperial Academy of Medicine in the Ming dynasty. This case is very short, but it rewards careful thought — a woman fell ill because of overwork. That word “lao” in Chinese means exactly that: labor, fatigue, all kinds of wear and tear. And what did the wear and tear produce? Three symptoms: tinnitus, headache, and body fatigue.
💬 Note from Doctor Luo: Put these three symptoms side by side and you can already see the direction. Watch that phrase “body fatigue” (ti juan) — a person who is always tired, always sleepy, without energy — what is that, most of the time? A deficiency pattern. Insufficient spleen qi, qi deficiency, depleted original qi — the main expression of all of these is a body that is profoundly, constantly tired. So whenever “body fatigue” appears, you must factor in “the constitution is deficient.” Go back and look at the tinnitus and the headache — they may well be caused by the deficiency too. That is exactly what Doctor Xue Lizhai seized on.
Who was the patient? A woman worn down by labor and depletion
Doctor Xue Lizhai did not record this woman’s name. But he wrote the cause down very clearly: due to overwork — labor, exhaustion, constant consumption. In those days, women did every kind of work in the household, and it was exhausting; add childbirth and nursing on top of that, and the drain on qi and blood was enormous. She was, in effect, ground down by her own life.
💬 Note from Doctor Luo: Tinnitus comes in many varieties, some excess and some deficiency. Excess patterns include liver fire — the fire of the liver and gallbladder surging upward. Deficiency patterns include yin deficiency, and spleen-qi deficiency. Headaches are likewise divided into excess and deficiency. So which kind was this? The two characters “ti juan” — body fatigue — basically give the answer: deficiency. Doctor Xue Lizhai’s verdict was blunt and immediate: this is insufficiency of original qi (yuan qi bu zu).
Why does qi deficiency cause tinnitus and headaches? When the qi sinks, the upper body goes empty
Doctor Xue Lizhai judged insufficiency of original qi. Doctor Luo Dalun explains the mechanism behind it thoroughly: what is middle qi (the qi of the spleen and stomach) for? To tonify the middle and lift the qi upward. When the middle qi is deficient, the qi mechanism sinks. Qi should fill the whole body — it reaches the highest point, the low places, the sides; all of it. Now the qi is insufficient and sinks downward — so what happens above? The upper body runs short of qi.
💬 Note from Doctor Luo: When the qi mechanism sinks, the place that suffers first is the upper jiao — the head and face. Tinnitus is upright qi being insufficient and clear yang failing to rise (qing yang bu sheng). Headache is also qi being insufficient — qi has no strength to rise and support the head, the qi and blood of the head and face run short, and function declines. Add dizziness, hoarse voice, and so on — all of them are qi running short, the upper body’s qi and blood supply failing. So in this case, from head to toe, it all comes down to one word: deficiency.
The prescription: Buzhong Yiqi Tang, plus mai men dong and wu wei zi
How did he treat it? Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction), with mai men dong (ophiopogon) and wu wei zi (schisandra) added.
💬 Note from Doctor Luo: Buzhong Yiqi Tang is the formula Doctor Xue Lizhai used most often — you will notice that whenever he saw insufficiency of original qi, he reached for Buzhong Yiqi. Why add mai men dong and wu wei zi? Because he suspected the patient might also have some yin deficiency. Mai men dong nourishes yin and moistens dryness; wu wei zi is sour, and sourness can gather the lung and restrain lung yin. Buzhong Yiqi Tang mainly tonifies qi and leans warm in nature — adding these two yin-nourishing, astringent herbs balances it out: you get qi tonification and yin nourishment at the same time, both qi and yin cared for together.
And the result? The woman’s illness was cured. What’s more — three years later she gave birth to a son! Look at that: it shows her body had genuinely recovered.
The illness returned: this time with missed periods, inner heat, and night sweats
But though the illness was cured, life did not let her go. Three years after the son was born, due to dietary exhaustion and overwork — postpartum fatigue, no one to help at home, hard labor on her own, meals at irregular times: she could not eat when she should, and ate poorly. The result: her old symptoms all came back, worse than before — tinnitus, headache, body fatigue. And new ones were added:
- Menstruation stopped — amenorrhea, her period simply did not come;
- Ri bu nei re — inner heat in the afternoon — as the sun went down, heat rose from inside the body and pushed outward;
- Spontaneous sweating and night sweats — she sweated at odd times during the day, and soaked the sheets while asleep at night.
💬 Note from Doctor Luo: Afternoon tidal heat and inner heat are classic signs of yin deficiency — the Inner Canon (Huangdi Neijing) says “yin deficiency produces inner heat; yang deficiency produces external cold” (yin xu ze nei re, yang xu ze wai han). In a yin-deficient person, heat wells up from inside in waves, like the tide — that is inner heat. And here is the rule of thumb: spontaneous sweating (sweating during the day) is qi deficiency; night sweats (sweating during sleep) are yin deficiency. This patient had both qi deficiency and yin deficiency, so she sweated day and night. At this point, simply tonifying qi was no longer enough.
Anatomy of the mechanism: once the spleen and stomach are injured, where does blood come from?
Where did the amenorrhea come from? Doctor Xue Lizhai saw it clearly: deficiency of yin blood. Why was the yin blood deficient? — Because the spleen and stomach were injured.
💬 Note from Doctor Luo: Chinese medicine holds that blood is produced by the spleen and stomach: the spleen and stomach transform food and drink into blood, then transport it throughout the body. This idea is actually very reasonable — where does Western medicine say the nourishment for hematopoietic stem cells comes from? From the nutrients absorbed by the spleen and stomach! So once the spleen and stomach are injured, there is no raw material, and blood diminishes; when blood deficiency lasts long enough, menstruation closes up. When the spleen and stomach are damaged, many women suffer menstrual problems, even amenorrhea — I have seen far too many such cases.
At this point Doctor Luo could not help launching into a long reflection on a tragedy of modern society:
💬 Note from Doctor Luo: Some women today deliberately diet and buy diet pills online. Criminal operators make them into “diet coffee” and “slimming coffee,” lacing them with banned weight-loss drugs — a batch was just caught recently. Some of these pills block the transmission of the appetite center in the nervous system, so you never feel hungry and don’t want to eat anything. But when mealtime comes and you don’t put food in, your stomach doesn’t know what hit it — and the result? The spleen and stomach are injured. Once the spleen and stomach are hurt, blood decreases, periods stop, amenorrhea sets in — it happens constantly! And there are girls who starve themselves on purpose — two cucumbers a day, nothing else, maybe a bit of fruit. That is playing with fire.
What is the ending for such dieters? Doctor Luo does not mince words:
💬 Note from Doctor Luo: Many of these girls end up with anorexia. How thin do they get? Legs like matchsticks, arms stretched out like skeletons. A woman looks at them and thinks: “Oh, so thin, so enviable — so bony!” A man looks and thinks one thing first: skeleton. Why do they become that thin? The spleen governs the muscles (pi zhu ji rou) — when the spleen and stomach are injured, the muscles shrink rapidly. But the most terrible thing is not the thinness — it is that the periods will certainly go wrong: after amenorrhea sets in, the uterus and ovaries both atrophy, the whole person ages alarmingly fast, and when she eventually marries she cannot bear children. All to chase “boniness” — and the spleen and stomach are ruined for life. This aesthetic is definitely broken! So remember this: when the spleen and stomach are hurt, blood diminishes; when blood is deficient, amenorrhea arrives. This woman is the perfect example — dietary exhaustion, overwork, injured spleen and stomach, the source of blood damaged; on top of that, yin had been consumed heavily, so there was yin deficiency with inner heat as well.
The second prescription: Liuwei Dihuang Wan combined with Buzhong Yiqi Tang — Doctor Xue Lizhai’s signature pairing
How did Doctor Xue treat her this time? Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) + Buzhong Yiqi Tang. After taking them — dun yu — she recovered immediately.
💬 Note from Doctor Luo: This is the usage I keep teaching everyone: Liuwei Dihuang Wan paired with Buzhong Yiqi Tang. In the first round the illness was milder, qi deficiency was the prominent pattern, so a single Buzhong Yiqi with a touch of yin nourishment was enough. This round both qi deficiency and yin deficiency were severe, so Buzhong Yiqi Tang tonified the qi and Liuwei Dihuang Wan nourished the yin — supporting qi and yin together. How do you take it? My usual suggestion is: in the morning take some Buzhong Yiqi Wan (if you have huang qi slices, brew huang qi water and take the pills with it — huang qi is the main ingredient of Buzhong Yiqi, so this strengthens the effect; and if there is a doctor nearby who can prescribe Buzhong Yiqi Tang as a decoction, drinking the decoction lifts the qi extremely fast), and in the evening take Liuwei Dihuang Wan — in the morning you raise the yang qi, in the evening you gather and nourish the yin qi, establishing a cycle of yin and yang. When qi is sufficient, it generates blood; when spleen qi is strong, it transforms yin blood; the circulation turns, upright qi is replenished, and yin blood is replenished with it.
And the outcome? The tinnitus, the headaches, that heavy exhausted state, the daily inner heat, the amenorrhea — all of it was cured.
Bonus: Doctor Xue Lizhai’s complete approach to tinnitus, and the Nine Orifices rule of the Inner Canon
This case was originally filed under the “amenorrhea” section, but Doctor Xue Lizhai — using this patient’s tinnitus as a springboard — talked at length about how to treat tinnitus. Doctor Luo says you can take these as reference without following them rigidly, but the thinking is very valuable:
💬 Note from Doctor Luo: Doctor Xue Lizhai said: blood deficiency with fire (people whose blood is depleted often carry fire) — use Si Wu Tang (Four Substances Decoction) plus zhi zi (gardenia) and chai hu (bupleurum); this is Zhu Danxi’s approach, tonifying blood while clearing heat. If that does not work, use Ba Zhen Tang (Eight Treasures Decoction) (Si Wu plus Si Jun Zi) with the previous additions. Qi deficiency with weakness — Si Jun Zi Tang (Four Gentlemen Decoction). Deafness and tinnitus caused by anger and rage — that is an excess pattern — Xiao Chaihu Tang (Minor Bupleurum Decoction) plus chuan xiong, dang gui, and zhi zi. Deficient tinnitus — Buzhong Yiqi Tang plus zhi zi. If it is severe before noon, treat it as fire — Xiao Chaihu Tang plus huang lian (coptis) and zhi zi; if severe before noon but with qi deficiency — Buzhong Yiqi Tang. If tinnitus is severe in the afternoon, treat it as blood deficiency — Si Wu Tang plus bai zhu and fu ling. If yin deficiency stirs fire, or combines with phlegm and thirst — you must use Liuwei Dihuang Wan, to strengthen the master of water (zhuang shui zhi zhu).
But the line Doctor Xue Lizhai quotes from the Huangdi Neijing (Inner Canon) is what Doctor Luo keeps stressing above all:
💬 Note from Doctor Luo: The Inner Canon says: “Headache and tinnitus — the nine orifices not functioning well — arise from the stomach and intestines.” (Tou tong er ming, jiu qiao bu li, chang wei zhi suo sheng ye.) What are the nine orifices? Two eyes, two nostrils, one mouth, two ears, plus the throat — nine openings in total. When the spleen and stomach are deficient, the ears, eyes and all nine orifices fall ill. So when you truly treat disorders of the five sense organs and the nine orifices, you must pay great attention to the spleen and stomach — get the spleen and stomach in order, and the nine-orifice illnesses become very easy to treat. Doctor Xue Lizhai’s case here was about amenorrhea, but the patient had tinnitus, and he judged: her original qi is deficient, qi deficiency predominates — so tend to the yin deficiency with Liuwei Dihuang Wan, and use Buzhong Yiqi Tang for the qi deficiency. When you meet tinnitus patients today, you should think exactly this way: if the tinnitus truly comes from qi deficiency, clear yang failing to rise, qi sinking instead of ascending, then Buzhong Yiqi Tang is the medicine. Whenever I treat tinnitus myself, I frequently work on the spleen and stomach and on qi and blood — many cases of tinnitus today are actually caused by spleen-stomach weakness, middle-qi insufficiency, middle-qi sinking, dragging dizziness, headache and all kinds of upper-jiao problems along with them. Just replenish the original qi and it resolves.
Closing: why did Buzhong Yiqi Tang become a famous formula?
Doctor Luo ends with a reflection: the reason Buzhong Yiqi Tang became a celebrated formula is that after Li Dongyuan created it, later physicians loved using it so much — Doctor Xue Lizhai pushed its use almost to the limit, and he must have been Li Dongyuan’s biggest fan. What does that tell us? The formula was created extremely well — and indeed, enormous numbers of people fall ill from this pattern, and the formula treats them remarkably well.
💬 Note from Doctor Luo: Look how crisp Doctor Xue Lizhai was — he barely used any miscellaneous formulas. To be honest, if a doctor — or an ordinary person — can understand a few ready-made classical formulas thoroughly and use them well, those formulas alone can resolve a very large share of illness. You don’t necessarily have to invent new formulas yourself. The ancient sages already worked things out brilliantly; the combinations inside are extremely well-balanced. We just study them and use them. Today, through this amenorrhea case, we talked about tinnitus and about Doctor Xue Lizhai’s usage of “Buzhong Yiqi paired with Liuwei Dihuang.” If your body is in total chaos — nothing you try works, the more you treat it the more disordered it gets — you can try establishing the yin-yang cycle: Buzhong Yiqi in the morning, Liuwei Dihuang in the evening, and a little Xiao Yao Wan (Free and Easy Powder) at noon — run this cycle and you will find the body gradually recovers.
Organized from Doctor Luo Dalun’s commentary on Doctor Xue Lizhai’s case records; the case comes from Xue’s Medical Cases (《薛氏医案》), by Xue Ji, Ming dynasty.